Monday, May 30, 2011

TV interview with Fanny Keefer

Dr. Randhawa's TV interview with Fanny Keefer is on youtube. Just press play to watch it!

Sunday, May 29, 2011

Kids' blindness: the leading cause is ...

I did some research on kids and blindness over the weekend and came up with some important information, which is especially relevant now as the warm weather brings kids outside to play sports.

Eye injuries are the leading cause of blindness in kids

Eye injuries are the leading cause of blindness in kids and most eye injuries among kids 11 to 14 occur while playing sports. While hockey is definitely a leading cause of eye injuries, other sports which are commonly thought of as safer and not as rough as hockey are also leading causes of eye injuries in children. Chief among these are baseball and basketball.

Baseball is a leading cause of eye injuries in children 14 and under. Research from the United Sates shows that Basketball is the leading cause of eye injuries among 15 to 24 year-olds.

The sports with the highest rates of eye injuries are baseball/softball, ice hockey, racquet sports, basketball, fencing, lacrosse, paintball and boxing .

Boys are more at risk than girls

Parents have to keep a closer eye on their boys than their girls. Boys 11-15 are five times more likely to end up in the emergency room with an eye injury than girls of the same age. Most of these injuries are sports related and related to projectiles including toys, guns, darts, sticks, stones and air guns.

What can you do to prevent the risk of eye injuries?

The first thing you can do is wear protective eye wear. The proper eye wear, made of the right materials, can prevent 90% of eye injuries. Some athletes will even play better with protective eye wear because they are less afraid of getting injured. I'll have more on protective eye wear in a subsequent post.

The most important thing you can do is to see your optometrist for a comprehensive eye health examination. This examination can reveal pre-existing conditions that can put a child (or any athlete, even an adult) at higher risk of blindness or vision loss in the event of an impact to the eye. When you know of the risk, you can take effective precautions to mitigate it and keep your eyes healthy.

As a reminder of how devastating and scary an eye injury can be, and how easy it is to prevent, read the post on Vancouver Canuck Manny Malholtra's eye injury. As I said in that earlier post, I believe that Manny Malholtra suffered a detached retina. An eye exam can determine if you are at higher risk of a detached retina. I'm not sure if Manny Malholtra had those risk factors, but if he did, he should have been wearing a visor.


Harrison, A., & Telander, D.G. (2002). Eye Injuries in the youth athlete: a case-based approach. Sports Medicine, 31(1), 33-40. 2U.S. Consumer Product Safety Commission. (2000). Sports and recreational eye injuries. Washington, DC: U.S. Consumer Product Safety Commission.

American Academy of Pediatrics, Committee on Sports Medicine and Fitness, American Academy of Ophthalmology, Eye Health and Public Information Task Force. (2004). Protective eyewear for young athletes. Ophthalmology, 111(3), 600-603.

Ducharme, J.F., & Tsiaras, W.G. (2000). Sports-related ocular injuries. Medicine & Health Rhode Island, 83(2), 45-51.

U.S. Consumer Product Safety Commission, 2000.

American Academy of Pediatrics, Committee on Sports Medicine and Fitness; American Academy of Ophthalmology, Eye Health and Public Information Task Force, 2004

Joint Policy Statement of American Academy of Pediatrics, Committee on Sports Medicine and Fitness; American Academy of Ophthalmology, Eye Health and Public Information Task Force. (2004). Protective eyewear for young athletes. Ophthalmology, 111(3), 600-603.

Tuesday, May 24, 2011

Only 38 years old and risking blindness

May is vision health month. So it is appropriate that Global News did a story on the six o'clock news on Victoria Day highlighting the dangers of getting automated sight tests from opticians rather than a comprehensive eye exam from a doctor of optometry. You are risking blindness.

Eye exams by a doctor of optometry assess the health of your eye and its component parts like the optic nerve. This is only way to diagnose glaucoma and other diseases early enough to prevent permanent vision loss.

Jason Inman was getting automated sight tests from an optician for years. He thought he was too young to need an eye exam from an eye doctor. He was wrong and and tragic consequence was permanent vision loss.

In his interview he talks about having a permanent smudge in his vision. This will likely never go away. For his eyes to get this bad, he must have suffered severe and permanent vision loss. Going by what he said in his interview, he is probably barely legal to drive, if is he is legal at all.

The good news is that now that he has gone to his optometrist, his disease is diagnosed and can be treated and the progression can be halted. The tragedy, of course, is that if he just visited his optometrist regularly he would not have suffered permanent vision loss. The thing that makes glaucoma so dangerous is that the person with the disease will not know that he has it until serious vision loss has already occurred.

It is true that this blog emphasizes glaucoma and eye exams but everyone out there needs to take their health seriously and be proactive and you need to see the eye doctor regularly. The consequences are just not worth it.

Another point is that BC's eye care regulations are obviously not rational if they allow automated sight testing because people are being lulled into a false sense of security regarding their health. Like Jason Inman said in his interview, he really did not think about whether his eye health was being looked after. That is understandable. In this busy world we often don't have time to think about our health. That is why we have doctors to look after us. I think that many people are just like Jason Inman. But I hope that they don't suffer the same consequences.

Dr. Randhawa interview on TV

Dr. Randhawa was on Studio 4 and gave an interview with Fanny Keefer. The show will be repeated throughout the day on Shaw Cable channel 4 today and then will be available on the show's website here.

Monday, May 9, 2011

NHL should require visors after Manny Malholtra's eye injury

At least one optometrist is telling National Hockey League players to wear visors.  She happens to be engaged to one of them. Andrew Ladd's fiancee has tried unsuccessfully to convince Ladd to wear a visor while playing for the Atlanta Thrashers, reports the Candian Press.  Visors are already required in international hockey rules.

Ladd is rethinking his stance on a visor after the horriffic injury to Canuck, Manny Malholtra, "Just seeing what happened to Manny Malhotra and those types of injuries, it's scary," Ladd told the Canadian Press. "It can end pretty quickly if you take one in the eye."  This is what happened to Malholtra:

An injury like this can lead to permanent blindness.  Under NHL rules, no player with one blind eye can play.  However, I don't think a rule is even necessary.  A player with one blind eye will probably not have the peripheral vision and necessary depth perception required to succeed at the NHL level.

The Canucks have not disclosed exactly what kind of eye injury Malhotra suffered, but there are a few possibilities.  Dr. Harbir Sian has a list of the possible injuries here, which include detached retina, corneal abrasion, cataract, glaucoma and fractured orbital bone.  In my opinion, the most likely injury is the dreaded retinal detachment.

Friday, May 6, 2011

Georges St. Pierre has Hyphema

Georges St. Pierre tweeted today that his eye condition is, in fact, hyphema, which is essentially blood in the front of the eye.  Here is his tweet:

I am so lucky my BJJ instructor Bruno Fernandes is an ophtamologist!!! I'll be in good hands!!!
My medical condition is called Hyphema. My vision is still blurry and my eye sensitive but the blood in my eye has now been absorbed...
My retina is find as well and my vision will come back to 100%!!! Can't be more happy!!

The blood usually reabsorbs, but a doctor needs to make sure that the process is resolving as it should and needs to monitor the pressure inside the eye.  If pressure increases or more bleeding occurs, hospitalization may be necessary.  A doctor will also give instructions regarding a series of precautions that a patient must take to ensure proper healing.

According to Georges' tweet, the blood in his eye has already reabsorbed, so he seems to be well on the way to recovery.

The best way to prevent hyphema is to wear protective eye wear because the condition is caused by trauma to the eye.  Are safety goggles permitted in UFC?

Thursday, May 5, 2011

UFC Fighter escapes retinal detatchment

UFC welterweight champion Georges St-Pierre had to take a break from competition because of an eye injury.

Following a fight that left him unable to see out of his left eye, he went doctors who suspected a detached retina. This is a serious condition that requires emergency surgery or else permanent blindness may result.

Luckily, Mr. St. Pierre's retina was not detached and he will fully recover in a short time.

This story highlights the importance of taking sports impact injuries seriously when they happen to the eye or the head generally. Detached retina due to impact can happen to anyone.

(But remember that retinal detachment can occur even without an impact. Go see an optometrist immediately or go to the ER if it is after business hours if you experience any sudden changes in your vision)

People who are highly myopic are at increased risk of retinal detachment and they need to be extra careful. Even if you have had laser surgery to correct your myopia, your risk level is still high. This is because the surgery merely alters the cornea at the front of your eye and does not change the physiology at the back of your eye where the retina is located.

I frequently have patients who come in to have their retina examined after being hit in the head or near the eye with a baseball or have suffered some other impact. I'm always pleasantly surprised that these patients know about the risk and take their health seriously!

Read more about Georges St. Pierre's injury here.